1750772059 NPI number — MICHAELA KATHRINE BARGER LPC CANDIDATE

Table of content: MICHAELA KATHRINE BARGER LPC CANDIDATE (NPI 1750772059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750772059 NPI number — MICHAELA KATHRINE BARGER LPC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARGER
Provider First Name:
MICHAELA
Provider Middle Name:
KATHRINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC CANDIDATE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750772059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RESOURCE MANAGEMENT
Provider Second Line Business Mailing Address:
1300 HOPPE BLVD., SUITE 1
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-436-7211
Provider Business Mailing Address Fax Number:
580-272-5757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 ARROWHEAD DR
Provider Second Line Business Practice Location Address:
ADOLESCENT TRANSITIONAL LIVING CENTER
Provider Business Practice Location Address City Name:
PAULS VALLEY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-331-2300
Provider Business Practice Location Address Fax Number:
405-331-2302
Provider Enumeration Date:
02/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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